Trauma Practice Questions

Q: Amount of blood loss in Stage I of hemorrhagic shock is -

<15%. ***<15%*** - Stage I (Class I) hemorrhagic shock is characterized by **minimal blood loss of up to 15%** of total blood volume (up to 750 mL in a 70 kg adult). - This is the **universally accepted ATLS definition** for Class I hemorrhage. - At this level, compensatory mechanisms maintain normal vital signs with minimal clinical manifestations. - Patients typically show minimal or no symptoms, with possible mild tachycardia only. * 100 bpm), tachypnea, and decreased pulse pressure, but blood pressure remains normal. - This is too broad to specifically define Stage I. * 120 bpm), altered mental status, and decreased urine output. - This is far beyond the compensated Stage I definition.

Q: Best approach for emergency thoracotomy in acute thoracic trauma is

Anterolateral thoracotomy. ***Anterolateral thoracotomy*** - Provides **rapid access** to the chest cavity for emergent situations, such as **cardiac tamponade** or **massive hemorrhage**, which are common in thoracic trauma. - Allows assessment and management of injuries to the **heart, great vessels, and lungs** with minimal repositioning in a critically ill patient. *Midline sternotomy* - Primarily used for **cardiac surgery**, offering excellent exposure to the mediastinum but is less ideal for general thoracic trauma with potential lateral injuries. - Takes **longer to perform** than an anterolateral approach and may not be suitable in an emergent, unstable trauma setting. *Parasternal thoracotomy* - Offers more limited access compared to other approaches, typically used for specific, localized procedures near the sternum. - Does not provide the **broad exposure** needed to manage the diverse and potentially widespread injuries seen in severe thoracic trauma. *Posterolateral thoracotomy* - Provides excellent exposure to the **posterior mediastinum, spine, and descending aorta**, but requires the patient to be in the lateral decubitus position. - Repositioning a severely injured trauma patient for this approach is often **impractical and time-consuming**, making it unsuitable for initial resuscitation.

Q: Head & face burn in infant accounts for what percentage of total body surface area?

18%. ***18%*** - In infants, the **Rule of Nines** is modified due to their proportionally larger head and smaller lower extremities compared to adults. - The head and face in an infant account for a larger percentage of the **total body surface area (TBSA)**, specifically 18%. *15%* - This percentage is inaccurate for an infant's head and face when calculating **TBSA** using the modified Rule of Nines. - While some areas might be 15% in adults, an infant's head is proportionally larger. *12%* - This percentage significantly **underestimates** the body surface area of an infant's head and face. - Using this value would lead to an incorrect assessment of **burn size** and potential under-resuscitation. *32%* - This percentage far **overestimates** the surface area of an infant's head and face. - Such a high value would result in an incorrect assessment of **burn severity** and potentially lead to over-resuscitation.

Q: Kehr's sign seen in splenic rupture is?

Pain over left shoulder. ***Pain over left shoulder*** - **Kehr's sign** is referred pain to the **left shoulder tip** due to diaphragmatic irritation, typically from blood, bile, or other irritants in the peritoneal cavity. - In splenic rupture, blood irritates the **left hemidiaphragm**, which is innervated by the **phrenic nerve** (C3-C5), leading to referred pain in the C3-C5 dermatomes of the shoulder. *Pain over right scapula* - Pain in the right scapula is more commonly associated with conditions affecting the **gallbladder** or **liver**, such as cholecystitis or biliary colic, due to irritation of the right hemidiaphragm. - This is not characteristic of splenic injury as the spleen is located on the left side of the abdomen. *Periumbilical pain* - **Periumbilical pain** typically arises from conditions affecting the **small intestine** or early stages of appendicitis when visceral innervation is involved. - While splenic rupture can cause diffuse abdominal pain, classic referred pain to the shoulder is a more specific diaphragmatic irritation sign. *Pain over renal angle* - Pain in the **renal angle** (costovertebral angle) is classically associated with conditions affecting the **kidneys** or **urinary tract**, such as pyelonephritis or kidney stones. - This location of pain is distinct from the diaphragmatic irritation seen in splenic rupture.

Q: Which of the following is NOT a feature of Cushing's triad?

Hypotension. ***Hypotension*** - Cushing's triad is an indicator of **increased intracranial pressure (ICP)** and classically presents with **hypertension**, not hypotension. - Hypotension would suggest a different problem, such as **spinal shock** or **hypovolemia**, which are not directly associated with Cushing's triad. *Bradycardia* - **Bradycardia** is a key component of Cushing's triad, resulting from vagal stimulation due to increased intracranial pressure. - This reflex reduces heart rate in an attempt to maintain cerebral perfusion. *Hypertension* - **Hypertension**, specifically a widened pulse pressure, is a cardinal feature of Cushing's triad, caused by systemic vasoconstriction to overcome increased ICP and maintain **cerebral perfusion pressure**. - It is a compensatory mechanism to push blood into the brain. *Irregular breathing* - **Irregular breathing patterns**, such as Cheyne-Stokes respiration or ataxic breathing, are characteristic of Cushing's triad, indicating brainstem compression [1]. - This irregular respiratory effort is due to direct pressure on the **respiratory centers** in the medulla [1].

Q: In which of the following conditions is neurosurgery not indicated?

Diffuse axonal injury (DAI). ***Diffuse axonal injury (DAI)*** - Neurosurgery is generally **not indicated** for diffuse axonal injury because the primary damage involves widespread shearing of axons throughout the white matter, rather than a focal, surgically accessible lesion. - Management of DAI is primarily **supportive**, focusing on managing intracranial pressure and optimizing cerebral perfusion, as there is no specific surgical intervention to reverse the axonal damage. *Subdural hematoma (SDH)* - Surgical intervention, such as a **craniotomy** or **burr hole drainage**, is often indicated for acute or subacute subdural hematomas, especially when they are large, causing mass effect, or leading to neurological deterioration. - The goal of surgery is to **evacuate the blood clot** and relieve pressure on the brain. *Epidural hematoma (EDH)* - **Epidural hematomas** are typically surgical emergencies that require urgent craniotomy for evacuation of the hematoma to relieve pressure on the brain. - This is due to their rapid development and tendency to cause significant **mass effect** and brain herniation. *Intracerebral hemorrhage* - Neurosurgery may be indicated for certain types of **intracerebral hemorrhage (ICH)**, particularly those that are superficial, large, causing significant mass effect, or located in a surgically accessible area. - The decision for surgery often depends on the **size and location of the bleed**, the patient's neurological status, and the risk of further deterioration.

Q: Best prognostic factor for head injury is:

Glasgow coma scale. ***Glasgow coma scale*** - The **Glasgow Coma Scale (GCS)** is a standardized tool used to assess the level of consciousness in head injury patients, providing an objective measure of neurological function. - A **lower GCS score** correlates with a greater severity of injury and poorer prognosis, making it the most reliable predictor of outcome. *Age* - While age can influence recovery, with **older patients generally having worse outcomes** due to less neural plasticity and pre-existing comorbidities, it is not the single best prognostic factor. - Younger patients often have better recovery potential, but their prognosis is still heavily dependent on the immediate severity of the brain injury. *Mode of injury* - The mode of injury (e.g., blunt trauma, penetrating injury) provides information about the mechanism and potential **types of injury**, but does not directly quantify the severity of brain damage or predict long-term outcomes as precisely as GCS. - While **high-impact injuries** tend to be more severe, the actual neurological deficit measured by GCS is a better indicator of prognosis. *CT* - **CT scans** are crucial for identifying specific neurological injuries like hemorrhage, edema, or fractures, which can guide immediate management. - However, the findings on a CT scan do not solely determine prognosis; a patient with a relatively normal CT can still have a poor outcome if their **GCS is low**, indicating widespread neuronal dysfunction not always visible on imaging.

Q: In emergency triage, which condition would typically receive the highest priority for immediate intervention?

Severe head injury. ***Severe head injury*** - A **severe head injury** with signs of deterioration (e.g., decreasing GCS, pupillary changes, signs of herniation) requires **immediate intervention** to prevent irreversible brain damage and death. - Initial management focuses on securing the **airway**, maintaining **adequate oxygenation and ventilation**, preventing **hypotension**, and urgent neurosurgical consultation. - In triage, severe head injury with potential for salvage takes highest priority as **secondary brain injury** from hypoxia or hypotension must be prevented immediately. *Multiple traumatic injuries* - While potentially life-threatening, this option is **too non-specific** - priority depends on which specific injuries are present (e.g., exsanguinating hemorrhage would be highest priority). - In isolation, "multiple traumatic injuries" doesn't indicate immediate life threat as clearly as a **severe head injury with neurological compromise**. - Management requires a **systematic ATLS approach** addressing life threats in order of priority. *Minor injuries* - **Minor injuries** are not immediately life-threatening and receive the **lowest priority** in emergency triage (typically "green" or non-urgent category). - These patients can safely **wait for treatment** without risk of deterioration or death. *Severe burns* - **Severe burns** are critical emergencies requiring urgent fluid resuscitation and wound care, but the question asks for **immediate intervention** priority. - While burns with **inhalation injury or airway involvement** would be highest priority, "severe burns" alone (without airway compromise specified) typically allows for brief delay for resuscitation setup. - The immediate threat from **acute brain herniation** in severe head injury often necessitates more urgent intervention than burn resuscitation in the first minutes of triage.

Q: Most common organ involved in air blast injury is?

Ear drum. ***Ear drum*** - The **tympanic membrane (eardrum)** is highly sensitive to changes in pressure, making it the most vulnerable and frequently injured organ during **air blast events**. - Its delicate structure can easily rupture due to the sudden, immense pressure wave. *Stomach* - While blast injuries can affect the gastrointestinal tract, causing conditions like **bowel perforation**, the stomach is less commonly and directly impacted than the eardrum. - Gastrointestinal injury usually results from a combination of **blast waves** and secondary effects like **fragmentation**. *Eye* - Eye injuries from blasts often involve **foreign bodies**, **ocular trauma**, or **thermal burns**, but direct **barotrauma** to the eye itself is less common than eardrum rupture. - The eye is somewhat protected by the bony orbit, offering a degree of shielding from direct blast effects. *Lung* - **Blast lung injury** is a serious, life-threatening condition involving pulmonary contusions, hemorrhage, and rupture of alveoli. - While significant, it is generally considered less frequent than eardrum perforation in overall blast injury cases.

Q: Rule of 9 in burns is used to denote?

% of total body surface area. ***% of total body surface area*** * The **Rule of Nines** is a standardized tool used to estimate the **percentage of total body surface area (TBSA)** affected by second- and third-degree burns in adults. * This estimation is crucial for guiding **fluid resuscitation** and determining the need for burn center transfer. *Depth of burns* * While important for treatment decisions, the Rule of Nines does not assess the **depth or degree of the burn** (e.g., first, second, or third degree). * Burn depth is typically assessed based on clinical appearance, sensation, and capillary refill. *Severity of burns* * Burn severity is a comprehensive assessment that considers **TBSA**, **depth**, location, patient age, and associated injuries, not solely the TBSA. * The Rule of Nines is only one component used in determining overall burn severity. *Type of burns* * The Rule of Nines is a method for estimating the **extent of burns**, regardless of their cause (e.g., thermal, chemical, electrical). * It does not classify the **etiology or type of burn injury**.

Question 1

Amount of blood loss in Stage I of hemorrhagic shock is -

Accepted Answer

<15%

Answer

<10%

Answer

<30%

Answer

<40%

Question 2

Best approach for emergency thoracotomy in acute thoracic trauma is

Accepted Answer

Anterolateral thoracotomy

Answer

Midline sternotomy

Answer

Parasternal thoracotomy

Answer

Posterolateral thoracotomy

Question 3

Head & face burn in infant accounts for what percentage of total body surface area?

Accepted Answer

18%

Answer

15%

Answer

12%

Answer

32%

Question 4

Kehr's sign seen in splenic rupture is?

Accepted Answer

Pain over left shoulder

Answer

Pain over right scapula

Answer

Periumbilical pain

Answer

Pain over renal angle

Question 5

Which of the following is NOT a feature of Cushing's triad?

Accepted Answer

Hypotension

Answer

Hypertension

Answer

Bradycardia

Answer

Irregular breathing

Question 6

In which of the following conditions is neurosurgery not indicated?

Accepted Answer

Diffuse axonal injury (DAI)

Answer

Subdural hematoma (SDH)

Answer

Epidural hematoma (EDH)

Answer

Intracerebral hemorrhage

Question 7

Best prognostic factor for head injury is:

Accepted Answer

Glasgow coma scale

Answer

Age

Answer

Mode of injury

Answer

CT

Question 8

In emergency triage, which condition would typically receive the highest priority for immediate intervention?

Accepted Answer

Severe head injury

Answer

Multiple traumatic injuries

Answer

Minor injuries

Answer

Severe burns

Question 9

Most common organ involved in air blast injury is?

Accepted Answer

Ear drum

Answer

Stomach

Answer

Eye

Answer

Lung

Question 10

Rule of 9 in burns is used to denote?

Accepted Answer

% of total body surface area

Answer

Depth of burns

Answer

Severity of burns

Answer

Type of burns

Trauma — MCQs

Trauma — MCQs

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